Familial Dyskeratotic Comedones

A 21-year-old man presented with extensive asymptomatic comedones and inflammatory papulonodules that had been present for the previous 7 years. The lesions had first appeared on the upper part of the trunk, subsequently spreading to the face, arms, axillae, thighs, groin, and buttocks. Physical examination revealed numerous monomorphic discrete black papules with firm central keratotic plugs. A few painful, inflamed nodules were present over the back (Figure 1). Pocklike scars were located predominantly over the face and back. His general health was otherwise normal, and he had not received any prior treatment for this condition. His father had similar lesions. Skin biopsy from the hyperkeratotic lesions revealed a crater-like invagination filled with lamellar keratinous material with foci of dyskeratosis (Figure 2).